Acne is a disorder of the pilosebaceous glands located on the face, chest and back. It is an almost universal disease, occurring in all races, predominantly among adolescents. The pathogenesis of acne is multi-factorial involving increased sebum production by the sebaceous glands, such as caused by increased activity of sebocytes, sometimes via peroxisome proliferator-activated receptor ligands; ductal hypercomification of the pilosebaceous unit of the dermis and epidermis and hyperkeratinization (increased activity of keratinocytes); inflammation; and the presence of the anaerobic bacteria Propionibacterium acnes (P. acnes).
The American Academy of Dermatology has reported that 85% to 100% of those aged 12-24 are affected by either intermittent or persistent acne, which in a number of adolescents results in scarring attributed to acne (Bershad, The Mount Sinai Journal of Medicine, Vol. 68, p. 279-286, 2001; White, Journal of American Academy of Dermatology, Vol. 39, p. S34-37, 1998). Furthermore, acne can remain problematic into the third to fifth decades of life, particularly in women. Tan et al., (Journal of American Academy of Dermatology, Vol. 44 (Supplement 3), p. 439-445, 2001), has reported that approximately 3% of all male adults and 12% of all female adults in the U.S. suffer from acne.
There is no cure for acne. Many medications are available for treating acne including topical retinoids (i.e., adapalene, tazarotene, tretinoin), antimicrobial and antibacterial agents (i.e., benzoyl peroxide, clindamycin, erythromycin, sodium sulfacetamide with or without sulfur), oral antibiotics (i.e., doxycycline, minocycline, tetracycline, azithromycin, trimethoprim-sulfamethoxazole (TMP/SMX), that primarily reduces the population of P. acnes, hormonal agents as anti-androgens (i.e., oral contraceptives) that decrease sebum secretion, systemic retinoids (i.e., isotretinoin), and topical aminolevulinic acid plus blue light (also known as photodynamic theory).
Various agents administered in acne treatments exhibit direct or indirect antibiotic activity but also directly suppress inflammation by decreasing neutrophil chemotaxis and down-regulate the expression of pro-inflammatory mediators. Oral antibiotics are indicated for several groups of patients with inflammatory acne. They include tetracyclines (i.e., tetracycline, doxycycline, minocycline, erythromycin, clindamycin, and cotrimoxazole).
With the high incidence of acne and other dermatological disorders that are of a major clinical health concern to both males and females, new innovative approaches are urgently needed at both the basic science and clinical levels to decrease the incidence of dermatological disorders.